Depression

Depression is a common mental illness which can happen to anyone irrespective of age, sex or wealth, leading to loss of interest or pleasure, feelings of guilt or low self worth, disturbed sleep or appetite, low energy and poor concentration. These feelings are not transitory they tend to stay with a person for a certain span of time ranging from six months to a year or more and for some keep returning.

Clients and depression

Depression has many forms. I usually see clients with diagnosed depression trying to become pregnant, depression during pregnancy and postnatally. My clients feel very comfortable coming in to see me with mental health issues in part because of my many years as a nurse and the knowledge, experience and professionalism that being a nurse requires.

Many clients share their own stories and concerns with me in our initial appointment chat. Some have battled depression for many years and their symptoms are managed with medication. Often they are concerned about the fertility drugs sending them back into depression during IVF and are very fearful. Some find their depression is triggered by stress and are afraid that the roller coaster of trying to conceive is going to tip them back into illess. Some suffer from extremely bad PMT and are afraid they will have difficulties with the hormones of pregnancy and post pregnancy.

Fertility and depression

Dr Miki Bloch of Tel Aviv University’s Medical Centre reports that stress, pre-existing depression and anxiety are more likely than the fertility drugs to affect depression during an IVF cycle.

He believes these factors combined can also impact on success rates.

In his research published in Fertility and Sterility he clarifies that different hormonal states can trigger depression in both short and long protocols of IVF. After embryo transfer there is a steep drop in oestrogen which can affect the emotional state , which is another reason the two week wait can be so difficult.The combination of stress surrounding treatment, a personal history of depressive or anxiety states and the sharp decline in oestrogen are the main contributing factors to depression in IVF therapy.The type of protocol is not important.

Antenatal depression

Antenatal depression is depression in pregnancy and includes the post natal period. It is more likely in women with a history of depression although it can occur in those with no history.

Awareness of your own personal mental health is vital as is working alongside the various doctors that are now in your life, GP, fertility doctor, obstetrician and getting advice on suitable medication.Early pregnancy can be a mixed bag of physical and mental symptoms, hormonal changes, unrelenting morning sickness or debilitating tiredness. Any of these can remove some of the joy from a pregnancy so wanted and anticipated. The guilt from having any negative feelings around pregnancy can difficult to accept and can be a hard emotion to share with others.

Helen’s story

Some women have quite severe symptoms which can come out of the blue as Helen McGurk discovered in her very honest article in the Newsletter in 2016. The famous metaphor of depression as a ‘black dog’ is how Helen described its arrival when six months pregnant. She couldn’t eat or sleep, her thoughts became increasingly dark and miserable , had suicidal thoughts and extreme anxiety about her ability to be a mum.

Worries about how she would be judged stopped the seeking of help initially. Eventually Helen did attempt to get help and unfortunately was seen by a GP whose advice was to go home and have a cup of tea! Luckily she persevered and her next GP was great. Medication was discussed and agreed on and a referral to a psychiatric unit to help with suicidal thoughts.

There are no specialist mother and baby psychiatric facilities in all of Ireland which is truly shocking. She was admitted to the best we have here, a general psych ward and did start improving slowly but surely.

RQIA recommendations

Lindsay from East Belfast suffered post natal depression but also suffered undiagnosed antenatal depression and believes if she had of been diagnosed during her pregnancy she would have saved her baby and herself a lot of pain.

She has been a vocal advocate for the opening of a specialist mother and baby psychiatric unit. The Regulation and Quality Improvement Authority ( RQIA) agrees with her and has set out 11 recommendations to overhaul service.

The report in 2017 also highlighted other failings, a wait of six months for treatment!, antidepressants being handed out too freely by GPs, parents having to turn to the Internet for advice and help. How incredibly lonely that would be.

How are women being monitored?

Women with a history of mental health issues should inform their GP and midwife so a plan can be drawn up to help with the pregnancy and postnatal period.

Midwives are such a great source of help and advice.Thanks so much to one of my many midwife clients for her help with detailing common mental health procedures she sees on a day to day basis on the frontline of patient care.

It is routine to ask about past history of depression , anxiety and stress at booking appointment. There are other indirect ways of questioning to find out mood using the Wooley questions.

Written information is given to parents in “The Pregnancy Book”and “Birth to Five” with sections about mental health concerns and how to find help.

Many times the same midwives see the same women at their appointments so are able to build a relationship and encourage opening up about emotional aspects.

Postnatal depression is discussed on discharge from hospital and leaflet given ,community midwife and health visitor also ask at their visits.

Postnatal depression

Symptoms of Postnatal depression include:

Persistant feeling of sadness

Loss of interest in the wider world

Feeling tired all the time

Difficulty bonding with your baby

withdrawing from contact with others

Frightening thoughts about hurting your baby

PANGS

PANGS NI is a closed Facebook group with over 400 members offering support for ante and postnatal depression women. Its founder set it up after struggling in the months after her daughter was born in 2012. Her symptoms started after a difficult birth with a massive panic attack which continued into a spiral of anxiety, more panic attacks and depression. Although her GP was kind and attentive her only port of call was antidepressants which she refused to take. Hours on the computer researching led to Cognitive Behavioural Therapy. CBT is a talking therapy that can help people manage problems by changing the way they think and behave. You can get CBT referrals through your GP although the waiting times can vary from practice to practice.

Another member Aisling suffered pain and sickness through her pregnancy and ended her pregnancy in a wheelchair. The constant pain and sickness took their toll on her mental health. After a negative experience trying to get help after suffering depression with her first child her experience second time around was much better.

A referral was sent to the perinatal mental health team. It took six months to be seen but the support was brilliant . The team are unfortunately overwhelmed and need more funding and support.

Moving forward

The Royal College of Midwives hopes a specialist perinatal unit could soon become a reality.

The Health Minister expressed in her reform of health services report an interest in exploring the establishment of an all- island perinatal centre as there are no specialist centres in the Republic of Ireland either. The minister is exploring the setting up of specialist community based perinatal mental health services in every trust. Although with Stormont not functioning at the moment any hopes of a fast implementation of these wishes is doubtful.

My role

Clients who come in to me for help with depression or anxiety are always under the care of their GP. They are receiving treatment if necessary from that GP or from their psychiatrist or psychologist.

My job is to help with increasing relaxation and work alongside the drugs, other modes of medical therapy and pregnancy symptoms through acupuncture .Nearly all of my ante and postnatal clients are receiving counselling, support and /or medication through their doctor. I am very rarely a stand alone therapy in these cases.

Client feedback.

As one of my clients kindly wrote to me:

Thank you Sharon for your kindness to me when I was pregnant and a bit lost.

I always felt you accepted me for who I was and how I was feeling that day. However bad.

You and your lovely room were just a haven where I could go and spend some time. I knew after your magic needles had done their work that I would feel better for days afterwards. Even my husband noticed the change!

I hope you don’t mind if I keep in touch and come in to see you with our new bundle. Would love you to meet Molly as you were such a part in her having a happy mum.

Joanne

(Permission received to use first names. )

Final thoughts

Hopefully our help for depression before and during pregnancy will improve with funding and good sense. It has always been my pleasure to do what I can to help and to hear the many positive stories of the help received through our NHS staff.

Please support any campaigns you come across to highlight the shortfalls in services. We unfortunately never know when it may impact someone close to us.